OPERATING ROOM

ADPO 510203

By:
Rozilawathy Ayop
Avelyn Ahlim
 OBJECTIVES

At the end of this lecture, student will be able to:-

1.Identify the categories of operating room.

2.Explain the size determinations of operating room.

3.Explain the substerile room

4.Describes the characteristics of operating room doors.

5.Explain the ventilation system in operating room

6.Describe the structures of operating room

7.Explain the furniture and equipment in the operating

room.
 INTRODUCTION
operation room is a restricted area to
peform surgery because:-

" The need to maintain a controlled

environment with minimal traffic for
sterile and aseptic technique"
HISTORY
 Categories of operating room

Class A-
size:150 Square feet minimum clear floor area, 12 foot
minimum clear dimension,
3-6 clearance at both sides, the foot and the head of
the operating table

Criteria:-
Minor surgical procedure can perform here which done
under topical and local anesthesia
example: AVF and phacoemuslsification
 Categories of operating room

Class B-
size:-250 Square feet minimum clear floor area, 15 foot
minimum clear dimension,
3-6 clearance at both sides, the foot and the head of
the operating table

Criteria:-
Provides for minor or major surgical procedures
performed in conjunction with oral, parenteral, or
intravenous sedation or under analgesic or dissociative
drugs.
 Categories of operating room

Class C
size:-400 Square feet minimum clear floor area, 18 foot
minimum clear dimension,
4-8 clearance at both sides, the foot and the head of
the operating table

Criteria:-
Provides for major surgical procedures that require
general or regional block anesthesia and support of vital
bodily functions.
American College of Surgeons publication 04GR-0001(May 2000)
 The importance of determine of size are:-

1. To accomodate big equipment such as microscope,

laser, video equipment or phaco machine.

2.To ensure safe traffic pathway of all four sides of sterile

field

3. Depends of speciality such as orthopedic, cardiothoracic

cases may need bigger OR than opthalmogy cases.

4.The complexity of surgery such as heart lung machine

and extra infusion pump for cardiac surgery.
( Timothy.et.al,2012)
 Substerile room

Definition: This is a
room accesible from
operation room.
Type of substerile
room: pic A
It may located
between two OR (pic
A)
A group of operating
room adjacent to
substerile room (pic b)
pic B
 Substerile room

Contains of:-enclosed storage, sink, warming cabinet ,

steam sterilizer

Enclosed storage:- keep sterile consumable

Warming cabinet:- 2 chambers (blanket and solution)

Blanket :- Not greater than 54degree celcius
Solutions:- Not greater than 43 degree celcius
Taken out solution is not allowed to return back to the
warmer
 Substerile room
Steam sterilizer

Only use if no other option

Normal Decontamination and cleaning step .
Sterilized wrapping instruments.

Advantage:
1.Saves time and steps
2.It reduces the need for other personnel to obtain sterile
instruments without left the OR.
3.For better care of delicate instruments and
equipments.
 Doors

Types of doors;-
Sliding door between corridors and OR.
Why?? microorganism settled in the OR can be
disturbed when door is swinging.
Microbial count usually at its peak increase during skin
incision due to gowing, walking, draping activities.

Substerile room always use swinging door so it should

keep remain close.
Always look through small windows before open this
door.

Doors
Size: 4 feet wide for ease moving , carts, trolley and
movable equipments.

Functions of operating doors:-

Doors must remain close all the times
Room air-handlers higher pressure than the halls to
minimize debris and dust pull toward sterile field.
Closed door-decrease the mixing of air between corridor
and ot
Decrease SSI incident. (Shital.N., 2011)
Maintain aseptic environment. (Rh and T)
Question:-How to prevent frequent open the door room?
 Humidity
-Humidity is the amount of water vapour present in the air.
-An air conditioning system control humidity.
- Range:-50% to 60%
- More than 70% - can permit condensation inside sterile
area
-Condensation can cause :-
1.Growth of microorganism
2. Spoil of equipment
-Patient safety measure:
1. Provides a conducive medium and allow a static charge
to flow to ground.
2. Prevent SSI due to condensation in OR ceiling, light, wall
 Temperature
Can be measured by Fehrenheit or Celcius.
Maintained range (18 to 22 degree celciuius)
Central air condition
Split air-cond is not permitted
Measure by thermohygrometer

Patient safety measure:-

Prevention from hypothermia for pead, geriatric & burn
patient
High temperature can cause sweating to periop team
therefore can control sweat from contaminate the sterile
field.
prevent activation of microorganism which will cause
infection to patient.
 Humidity & Temperature

-Nursing responsibility:-
1.Recommended practice by JCIA - daily monitoring
2.Report if humidity is out of range
3.To ensure half an hour before operation, temperature
and humidity is at normal range.
 Ventilation
Function -
1.Provide ventilation system compatible with the
needs of sterile team for aseptic air quality.
2.Provide fresh air
3.Prevent accumulation of anesthetist gas and
microbiologic particles in the room.
15:3 (ACH :outside air) recommended for procedure
room
20:4 -recommended for general OR
(2014 AIA Guidelines for Design and Construction HealthcareFacilities)

Scavanging system- a vacuum system used to minimize

air pollutants that cause heath risk
 Ventilation
ype of ventilation system
-T

1.Plenum air flow system

2. Laminar air flow system

Plenum Air Flow

-This system relies on pressure
being greater inside theatre than
outside.
--Provision of clean air is via
wall/ceiling diffusers and let out of
vents above floor level.
However, air may pass out of other
openings such as doors.
This system, therefore, is less
reliable in maintaining an aseptic
environment through opening of
doors of movement of personnel
in and out of theatre.
 Laminar air flow
Is a high-pressure, unidirectional air moving diffuser
housed in a cluster , in a wall or ceiling enclose.
It designed to flow uninterrupted from the cleanest area
to the less clean area into air return grilles in the lower
sidewalls.
Sir John Charnley-1950s
Type of air flow
Air flow
Tiny linear Horizontal

Vertical
 Laminar Air Flow

Obstacles To laminar Air Flow Effectiveness

objects pass between can shed particles that can
contaminate surgical site.
thermal Plume- heat emanating and rising from team
members can change the course of laminar flow.
Physical barriers:-
spotlight
ceiling booms
mayo stand over the patient
microscope,laser c-arm
opening and closing doors.
 Laminar air Flow

-Hepa Filter-microbial filter in ducts ,filter the air. 99.7%

efficient in removing particle larger than 0.3mm.
 Laminar Air Flow

The airs enters the ceiling through laminar air flow.

Due to positive pressure in OR, airs leaves or through

grills at floor level.

OR environment will maintain well if there is no

disturbance of the flow.
 Ventilation system
-The ventilation system in OR is seprated from hospital
general system and should be :
-cleaned
-maintained
-inspected
-Do PPM
 Floors

Currently, floor were made by seamless polyvinyl

chloride

up to 5 to 6inchs welded into place.

Safety measure:-
-slip-proof
-easy to clean
-Not so hard- can cause back pain
-bacteriostatic
-colour that wont cause eye fatigue
 Walls

Walls should be:-

Pastel colour
hard vinyl material- easy to clean and maintan
Seams- sealed with silicon sealant\
Laminated polyster or smooth painted plaster
 Ceiling

Minimum height 10feet

The height depends on amount and types of ceiling
mounted equipment.
Ceiling colour should be white to reflect 90% of the light
in even dispersion
Reinforced with steel beam to support the load.
if movable or trach ceiling mounted, it should be away
from OR bed

Safety measure:-High dusting cleaning prevent from dust

accumulation
Piped-In Gases,Computer Lines, and
Electrical System.

Vacuum for Suction

Anesthetic Gas evacuation
Compressed Air may be piped into the
Oxygen OR
Nitrous Oxide

*for safety,the hoses used to pipe in the gases and evacuate waste anesthetic
gas are colour coded.
**the pin-index safety connectors that fit into the outlets have different shapes to
prevent placing the wrong gas supply to the anesthesia mechine.
***to protect other rooms,the supply of oxygen and nitrous oxide to any room
can be shut offat control panels. A panel lights comes on, and a buzzer
sounds in the room and in the maintanance department.
Computers are widely used in the OR. They are commonly
located adjacent to the anesthesia mechine and the
circulating nurses desk.

Electrical outlets are grounded and must meet the

requirements of the equipment that will be used.

Multiple electrical outlets should be available from separate

circuits. all personal must be aware that the use of
electricity introduces the hazards of electrical shock,power
failure and fire.
*This hazards can be prevented by taking these
following precautions

Use only electrical equipment designed and

approved for use in the OR,and must have cords of
adequate length and current-carrying capacity to
avoid overloading.
Test portable equipment immediately before use.
Discontinue use immediately if any malfunction take
place,and report any faulty electrical equipment.
If a ground fault buzzer sounds,unplug the last
device engaged and remove it from service.
 Lighting

General illumination is furnished with static ceiling lights

and mobile sportlights,which is white fluorescent but they
may be incandescent.
Lighting should be distributed troughout the room without
harsh shadows especially in sterile field.
Intraoperatively,the lighting should not cause the organs to
appear discoloured.
 Cont

For minimized eye fatique,the ratio of intensity of general

room lighting to that at the surgical site should not exceed
1:5, preferably 1:3 , and should be maintained in corridors
and scrub areas and in room itself so that the surgeon
becomes accustomed to the light before entering the sterile
field.

Colour and hue of the lights also should be consistent.

Cont..

The overhead operating light must

Make an intense light into the incision without glare on
the surface
Provide a light pattern that has a diameter and focus
appropriate for the size of the incision.
Be shadowless.
Produce the blue-white colour of daylight.
Be freely adjustable to any position or angle with either a
vertical or a horizontal range of motion.
Produce a minimum of heat to prevent injuring and drying
exposed tissues.
Be easily cleaned and maintained.

34
Monitoring Screens

Monitors and computers are designed to keep the OR

team aware of the physiologic function of the patient
throughout the surgical procedure and to record patient
data.

Widely used for teaching surgical techniques and able to

minimize the number of visitors in the OR which in the
interest of sterile techniques.

Provide a better view for more people to see the

procedures.
Radiograph screens or View boxes

many facilities have changed from plain film viewing to

digital computer monitors, may be articulated arms
extend from the wall or ceiling.
Lighted view boxes are still useful in the event old films
are brought from the archives.
Can also be used as indirect lighting during light
procedures.
X-ray view boxes can be recessed into the wall and the
best location is in the line of vision of the surgeon
standing at the OR bed.
Should be placed within reach of each view box station.
 Clocks
2 clocks should be placed in each OR

I.Standard clock analog / digital for basic time observation

should be visible from the field.
II.Time elapsed clock
**useful for indicating one or more predetermines periods of
time have passed.
**may be used during procedure example arterial
occulsion,tourniquet,or cardiac arrest.

Start,stop or resit buttons should be within reach of the

anesthesia provider/circulating nurse.
Cabinets or Carts

Closed-in stationary may be supplied in each

OR.
Supplies for the types of surgical procedures
done in the room are stocked or every OR
maybe stocked to help eliminate traffic in out of
the OR.
Made of stainless steel or hard plastic and
should be easy to clean.
Gloves used in patient care should be removed
when opening the cabinets & removing supplies.
Furniture and other equipments
Stainless steel furniture is plain,durable,and
easily cleaned.
Each OR is equipped with basic items
-OR bed
-Instrument tables
-Mayo stand
-Small table
-Ring stands for basin
-Anesthesia mechine with table
-Sitting stools
-Suction canister
-Kick bucket in wheeled bases.
-Laundry hamper frame
-Writing surface
-Computer station
Communication System
Is a vital link to summon routine or
emergency assistance to relay
information.
This communication system may
connect the OR with the clerk
receptionists desk,nurse manager
office,blood bank,pathology,radiolody etc.

**surgical suite are equiped with

telephones,intercoms,call lights,video
equipment,computers
Piped-In Gases,Computer Lines, and
Electrical System.

Vacuum for Suction

Anesthetic Gas evacuation
Compressed Air may be piped into the
Oxygen OR
Nitrous Oxide

*for safety,the hoses used to pipe in the gases and evacuate waste anesthetic
gas are colour coded.
**the pin-index safety connectors that fit into the outlets have different shapes to
prevent placing the wrong gas supply to the anesthesia mechine.
***to protect other rooms,the supply of oxygen and nitrous oxide to any room
can be shut offat control panels. A panel lights comes on, and a buzzer
sounds in the room and in the maintanance department.
Computers are widely used in the OR. They are commonly
located adjacent to the anesthesia mechine and the
circulating nurses desk.

Electrical outlets are grounded and must meet the

requirements of the equipment that will be used.

Multiple electrical outlets should be available from separate

circuits. all personal must be aware that the use of
electricity introduces the hazards of electrical shock,power
failure and fire.
*This hazards can be prevented by taking these
following precautions

Use only electrical equipment designed and

approved for use in the OR,and must have cords of
adequate length and current-carrying capacity to
avoid overloading.
Test portable equipment immediately before use.
Discontinue use immediately if any malfunction take
place,and report any faulty electrical equipment.
If a ground fault buzzer sounds,unplug the last
device engaged and remove it from service.
 Lighting

General illumination is furnished with static ceiling lights

and mobile sportlights,which is white fluorescent but they
may be incandescent.
Lighting should be distributed troughout the room without
harsh shadows especially in sterile field.
Intraoperatively,the lighting should not cause the organs to
appear discoloured.
 Cont

For minimized eye fatique,the ratio of intensity of general

room lighting to that at the surgical site should not exceed
1:5, preferably 1:3 , and should be maintained in corridors
and scrub areas and in room itself so that the surgeon
becomes accustomed to the light before entering the sterile
field.

Colour and hue of the lights also should be consistent.

Cont..

The overhead operating light must

Make an intense light into the incision without glare on
the surface
Provide a light pattern that has a diameter and focus
appropriate for the size of the incision.
Be shadowless.
Produce the blue-white colour of daylight.
Be freely adjustable to any position or angle with either a
vertical or a horizontal range of motion.
Produce a minimum of heat to prevent injuring and drying
exposed tissues.
Be easily cleaned and maintained.

52
Monitoring Screens

Monitors and computers are designed to keep the OR

team aware of the physiologic function of the patient
throughout the surgical procedure and to record patient
data.

Widely used for teaching surgical techniques and able to

minimize the number of visitors in the OR which in the
interest of sterile techniques.

Provide a better view for more people to see the

procedures.
Radiograph screens or View boxes

many facilities have changed from plain film viewing to

digital computer monitors, may be articulated arms
extend from the wall or ceiling.
Lighted view boxes are still useful in the event old films
are brought from the archives.
Can also be used as indirect lighting during light
procedures.
X-ray view boxes can be recessed into the wall and the
best location is in the line of vision of the surgeon
standing at the OR bed.
Should be placed within reach of each view box station.
 Clocks
2 clocks should be placed in each OR

I.Standard clock analog / digital for basic time observation

should be visible from the field.
II.Time elapsed clock
**useful for indicating one or more predetermines periods of
time have passed.
**may be used during procedure example arterial
occulsion,tourniquet,or cardiac arrest.

Start,stop or resit buttons should be within reach of the

anesthesia provider/circulating nurse.
Cabinets or Carts

Closed-in stationary may be supplied in each

OR.
Supplies for the types of surgical procedures
done in the room are stocked or every OR
maybe stocked to help eliminate traffic in out of
the OR.
Made of stainless steel or hard plastic and
should be easy to clean.
Gloves used in patient care should be removed
when opening the cabinets & removing supplies.
Furniture and other equipments

Stainless steel furniture is plain,durable,and easily

cleaned.
Each OR is equipped with basic items
-OR bed
-Instrument tables
-Mayo stand
-Small table
-Ring stands for basin
-Anesthesia mechine with table
-Sitting stools
-Suction canister
-Kick bucket in wheeled bases.
-Laundry hamper frame
-Writing surface
-Computer station
Communication System
Is a vital link to summon routine or
emergency assistance to relay
information.
This communication system may
connect the OR with the clerk
receptionists desk,nurse manager
office,blood bank,pathology,radiolody etc.

**surgical suite are equiped with

telephones,intercoms,call lights,video
equipment,computers
 REFERENCES
1. Guidelines for Optimal Ambulatory Surgical Care and Office-Based Surgery. (2000).American
College of Surgeons publication 04GR-0001. Retrieved from
https://dch.georgia.gov/sites/dch.georgia.gov/files/imported/vgn/images/portal/cit_1210/58/57/158183
631What_size_Operating_Room_do_you_need.pdf

2. Nancymarie.H.P (2017) . Berry & Kohn's Operating room technique (13th ed). St.Louis, Missouri :
Elsevier.

3. Timothy. S.J.Shine.,et.al. ( 2012). Specialized Operating Room. AmericanSociety of

Anesthesiology. Retrieved from https://www.asahq.org Resources Resources From ASA
Committees.
 QUIZ
Minimum height for ceiling is 14 feet.
OR classification into 4 class.